Improving Epilepsy Quality of Care

April 18, 2016

To improve the quality of care for patients with epilepsy, AAN updated a set of measures and guidelines in 2014, but does a gap still exist?

With the aim of improving the quality of care for patients with epilepsy, the American Academy of Neurology (AAN) established a set of measures and criteria in 2009. Updated in 2014, AAN positioned this set of measures to improve the quality of outcomes. But a gap still remains, according to a team of researchers who found the set of measures is not always utilized to the fullest.

The team from Mount Sinai Beth Israel, New York, NY presented their analysis at the AAN’s 68th annual meeting in Vancouver on April 16. They found a way to gauge the quality of care epileptic patients receive by examining physicians’ adherence to the set of quality measures.

The team reviewed notes from patient records of 60 randomly selected physicians in the Comprehensive Epilepsy Program, Mount Sinai Beth Israel. This review was conducted for one full calendar year. The notes were measured against the following set of Epilepsy Quality Measures (EQM). Each note scored 1 if the measure was followed. The percentages represent rates of adherence to their corresponding measures.

seizure frequency100%
seizure intervention100%
appropriate surgical referral100%  
treatment side effects addressed95%
etiology, seizure type, and epilepsy syndrome specified85%
personalized education58%
counseling for women of childbearing potential35%
psychiatric screening   8%

Although the study was small (limited to only 60 subjects within one facility), the team’s conclusion hits home. The measures that correspond with the three lowest rates of adherence demonstrate precisely the components of patient care that need serious consideration. These three EQMs could, in fact, serve as the basis for three new recommendations:

1. that physicians screen for psychiatric disorders. Patients with epilepsy accompanied with psychiatric or behavioral disorders are not uncommon. A significant number of those patients are so uncooperative they often do not get referred to specialized centers soon enough.

2. that physicians counsel women of childbearing age. Women in this demographic need to know  relative risks, for example, of major congenital malformation from in utero exposure to antiepileptic drugs.

3. that personalized education topics could be expanded and documented consistently to improve patient safety and understanding.

A final take away, an incidental discovery of significance was that only 2 of the physicians used clinic templates to record patient information. They are also the only physicians who scored 100% on all EQMs. The remaining 4 physicians used a free text or cut and paste method of note recording. A final recommendation, then, might be to incorporate and standardize template utilization into physicians’ procedure of recording patient information.

While epilepsy is widely recognized, it is a complex disease, still often misunderstood, misdiagnosed, and ineffectively treated. The long road ahead continues to be daunting as the search for answers is as great as ever.

But utilizing AAN’s Epilepsy Quality Measures consistently as recommended above, at best will help to reduce the number of Americans who live with uncontrolled incidents of epileptic seizures.

Reference: Lai G, et al. A Quality of Care Analysis Utilizing the 2014 American Academy of Neurology Updated Quality Measurement Set for Patients with Epilepsy. Poster presentation P1.067, Apr 16, 2016. AAN Annual Meeting, Vancouver, British Columbia.